Provider Demographics
NPI:1386903029
Name:BINGAMAN, MARSHALL SCOTT (CPTA)
Entity type:Individual
Prefix:MR
First Name:MARSHALL
Middle Name:SCOTT
Last Name:BINGAMAN
Suffix:
Gender:M
Credentials:CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 E AMORY ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-6740
Mailing Address - Country:US
Mailing Address - Phone:816-838-6204
Mailing Address - Fax:
Practice Address - Street 1:800 S WHITE OAK RD
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MO
Practice Address - Zip Code:65706-2231
Practice Address - Country:US
Practice Address - Phone:417-859-3701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008020464314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility